What Actually *Is* PMS?

You’ve probably heard of PMS—but you might not know exactly what it means. PMS is an acronym that stands for premenstrual syndrome, and the term tends to be a catch-all for the not-so-nice parts of our monthly cycles, like cramps, mood swings and bloating. 

Technically speaking, according to the American College of Obstetricians and Gynecologists (ACOG), PMS is a cluster of nearly 200 different possible physical and mood symptoms that occur one to two weeks before menstruation. (So fun!) The good news? PMS symptoms usually vanish once the period actually starts. 

PMS often gives periods a bad rap, and for good reason—research shows that PMS affects roughly 85% of people with periods, and not in a minor way. In a study of 33,000 women, 80.7% reported reduced productivity during workdays when they had their period, and 13.8% reported missing work due to period complaints altogether. When PMS starts interfering with your daily life, it’s time for something to change. 

Thankfully, PMS can be ameliorated through small habit shifts and lifestyle changes such as improved nutrition (yep, eating for your period is a real thing), vitamin and mineral supplementation (that’s where we come in) and self-care (as if you needed another reason to take a nap, amiright?). 

Here’s more info about PMS—why it happens, when it happens—and what you can do about it. 

When PMS Strikes

Let’s start with a little light biology. Your menstrual cycle is divided into four phases: the follicular phase, ovulatory phase, the luteal phase, and the menstrual phase. During each of these phases, the five major hormones (estrogen, progesterone, testosterone, follicle-stimulating hormone and luteinizing hormone) shift in concentration. Even the slightest hormone shift can have big repercussions, which is why you might wake up in a totally different head space from one day to the next. 

PMS occurs during the luteal phase, which is generally considered day 22-28 of your cycle—though this varies by person. During this time, two hormones, estrogen and progesterone, have been building up to support a potential pregnancy. If it turns out that the egg is unfertilized (i.e. you’re not pregnant), your body will prepare to shed the endometrial lining of your uterus, which results in a rapid free-fall of both estrogen and progesterone. 

That’s typically the catalyst that kicks off the cascade of resulting symptoms in the days or week before you start menstruating.

Wide-Ranging Symptoms

Speaking of symptoms, the ones ascribed to PMS number in the hundreds and may range from mild to debilitating. You’re probably familiar with at least some of the main culprits: bloating, cramping, breast tenderness, headache, sugar cravings, increased appetite, fatigue, irritability, anger, anxiety, mood swings, aggression, depression, loss of focus, crying, and insomnia, just to, uh, name a few.

It’s a real grab bag—your PMS symptoms could vary month to month or stay pretty consistent. In some women, one ailment is more salient while others have a few that are front and center. 

Not that you needed a reason to call your mom; but find out if she suffered from PMS too. If so, you’re more likely to have that lovely pleasure as well, writes registered dietitian/nutritionist Dana Pitman, MS, RD, CDN. Another bonus? If you have a pre-existing mood or anxiety disorder, such as depression, you’re also at higher risk of PMS.

Why PMS Occurs

There are several factors at play in why PMS is so…present. Science doesn’t have a definitive, singular reason for why PMS occurs, but there are a few theories floating around. 

The first is estrogen dominance. PMS has long been thought of in relation to too-high levels of estrogen in the body—but there’s more than meets the eye here. If you suffer from PMS, you may not actually have more estrogen circulating in your blood, but you could have a reduced clearance rate of estrogen from your body (possibly due to a sluggish liver), a lower level of progesterone (which throws off the estrogen/progesterone ratio, making it *seem* like you have more estrogen when really you just have lower progesterone), or, says Pitman, a highly sensitive system that’s simply more attuned to hormonal changes (lucky you!). 

Let’s take a closer look at the liver’s role in all this. One of the liver’s primary functions is to clear excess hormones from the blood. Because this organ is so dependent on water-soluble B vitamins, any habits that deplete these nutrients can alter liver function. We’re talking taking birth control pills, drinking alcohol and/or coffee, and high levels of stress—you know, regular stuff you deal with probably on a daily basis. 

But there’s hope: Research shows that supplementing with a B complex, zinc and magnesium can help restore liver function and may in turn help clear estrogen more efficiently and improve PMS symptoms. 

Additionally, “be vigilant with lifestyle choices,” suggests Pitman. Think daily exercise, adequate water, plenty of fiber, healthy fats, and probiotics, plus generally trying to moderate your alcohol intake and stress levels. We know, easier said than done, but all of these small steps can add up to big benefits in terms of liver support to help get rid of excess estrogen. 


Your PMS Prevention Kit

The most important thing to recognize is that you don’t *have* to suffer from PMS every month—and you also don’t have to just pop a Motrin and hope for the best. The following nutrients (conveniently all found in Marea) have great research in support of their use for PMS relief. 

  • B-complex vitamins: A range of B vitamins are essential for the metabolism and functioning of several neurotransmitters. B6 specifically has been shown to help combat depression and anxiety as it relates to PMS. 
  • Vitamin C: A crucial component for iron absorption, vitamin C ensures that iron from your diet is stored in a form that’s more usable by your body.
  • Vitamin D: Studies suggest that many people with PMS have lower levels of vitamin D, and that high-dose supplements of the vitamin are associated with reduced PMS symptoms such as backache and tendency to cry easily.
  • Calcium: A calcium deficiency or altered absorption of the mineral has been shown to increase risk of PMS symptoms. Supplementing calcium has been shown to reduce depression, anxiety, and bloating. 
  • Magnesium: This mineral is essential for helping the uterus contract during the menstrual cycle to help rid the body of the endometrial lining. It’s also a key factor in dopamine synthesis in the brain (a neurotransmitter), an imbalance of which can lead to anxiety
  • Selenium: Your thyroid, which controls a large portion of your body’s hormone regulation, relies on selenium to function properly, and this trace mineral is often lacking in our diets.
  • Zinc: Higher zinc levels have been associated with reduced risk of PMS. An essential cofactor for more than 300 different enzymes, zinc plays a major role in numerous actions within your body, including hormone metabolism.

How to Eat For Your Period

What about food? I  could do an entire article on nutrition for your period (stay tuned!), but there’s a few main points I’ll share here, namely:

  • During your luteal phase, try to scale back on your alcohol, caffeine, sugar and processed food consumption. 
  • Ramp up your intake of fiber throughout the month: think dark leafy greens, berries and complex carbs (sweet potatoes, brown rice, oats).
  • Support liver health by filling your plate with beets and bitter greens (arugula, watercress, dandelion greens). 
  • Increase your calcium intake by eating more grassfed dairy, nuts, broccoli, and canned salmon.
  • Get plenty of plant-based fats through foods such as olives, coconut, avocado, and nuts and seeds.

Ultimately, it comes down to self-care. What if you actually embraced your PMS instead of gritting your teeth the whole way through? Can you make a conscious choice to slow down during your luteal phase each month and give your body the necessary rest, foods and supplements it needs while you’re in this transition? (Thankfully, that’s where Marea comes in!) 


References

Bahrami A, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecological Endocrinology. 2018 Aug 3;34(8):659-63.

Bertone‐Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Archives of Internal Medicine 2005;165:1246‐52. 

Fathizadeh S, Amani R, Haghighizadeh MH, Hormozi R. Comparison of serum zinc concentrations and body antioxidant status between young women with premenstrual syndrome and normal controls: A case-control studyInt J Reprod Biomed (Yazd). 2016;14(11):699–704.

Kaewrudee S, Kietpeerakool C, Pattanittum P, Lumbiganon P. Vitamin or mineral supplements for premenstrual syndromeCochrane Database Syst Rev. 2018;2018(1):CD012933. Published 2018 Jan 18. doi:10.1002/14651858.CD012933

Kiani F, Sayehmiri K, Sayehmiri F, Naghdi N, Ghafari M, Asadi-Samani M, Bahmani M. Effects of vitamin B6 on premenstrual syndrome: A systematic review and meta-Analysis. Journal of Chemical and Pharmaceutical Sciences. 2016;9(3):1346-53.

Mayo J, Joseph L. Premenstrual syndrome: a natural approach to management. Clin Nutr Insights. 1997;5:1-8.

Pitman D. Nutrition's role in premenstrual syndrome—learn about this disorder and the role genetics, environment, and diet may play in its onset. Today's Dietitian. 18(3):50.

Shobeiri F, Araste FE, Ebrahimi R, Jenabi E, Nazari M. Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics & Gynecology Science. 2017 Jan 1;60(1):100-5.

Thys-Jacobs S. Micronutrients and the premenstrual syndrome: the case for calciumJ Am Coll Nutr. 2000;19(2):220-227.

ABOUT THE AUTHOR:
Jessica Waller Welltribe @welltribe.co

Find her most recent musings on nutrition and self-care at WELLTRIBE and @welltribe.co.


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